CHAPTER 5

Copyright Copyright ©© 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 1

CHAPTER 5CHAPTER 5CHAPTER-SPECIFIC GUIDELINES CHAPTER-SPECIFIC GUIDELINES

(ICD-9-CM CHAPTERS 1-8) (ICD-9-CM CHAPTERS 1-8)


ICD-9-CM, Chapter 1ICD-9-CM, Chapter 1

• Infectious and Parasitic DiseasesInfectious and Parasitic Diseases

– Divided based on etiologyDivided based on etiology(cause of disease)(cause of disease)

– Many combination codesMany combination codes

– ExampleExample: 112.0 candidiasis infection of : 112.0 candidiasis infection of mouth, which reports both organism and mouth, which reports both organism and condition with one codecondition with one code


Multiple CodesMultiple Codes

• Sequencing must be consideredSequencing must be considered

– UTI due to UTI due to Escherichia coliEscherichia coli

• 599.0 (UTI) etiology599.0 (UTI) etiology

• 041.4 041.4 (E. coli)(E. coli) organism organism

– 041 category is a secondary-code only041 category is a secondary-code only


Section I.C.1.a,d,e Human Section I.C.1.a,d,e Human Immunodeficiency VirusImmunodeficiency Virus• Code HIV or HIV-related illness ONLY if Code HIV or HIV-related illness ONLY if

stated asstated as confirmed in diagnostic confirmed in diagnostic statementstatement

• 042 HIV or HIV-related illness042 HIV or HIV-related illness

• V08 Asymptomatic HIV statusV08 Asymptomatic HIV status

• 795.71 Nonspecific HIV serology795.71 Nonspecific HIV serology

• Once an HIV diagnosis cannot code V08Once an HIV diagnosis cannot code V08


Section I.C.1.a.2.f. Previously Section I.C.1.a.2.f. Previously diagnosed HIV-related illnessdiagnosed HIV-related illness

• Code Code prior diagnosisprior diagnosis HIV-related disease HIV-related disease 042 (HIV)042 (HIV)

• NEVER assign these patients to:NEVER assign these patients to:

– V08 (asymptomatic) or V08 (asymptomatic) or

– 795.71 (Nonspecific795.71 (Nonspecific serologic evidence serologic evidence of HIV)of HIV)


Section I.C.1.a.2. Section I.C.1.a.2. Selection and sequencing Selection and sequencing of HIV codesof HIV codes• If admitted for HIV-related illness If admitted for HIV-related illness

(e.g., pneumonia)(e.g., pneumonia)

– Code 042 (HIV) Code 042 (HIV)

– Followed by current illness Followed by current illness (pneumocystic carinii, 136.3)(pneumocystic carinii, 136.3)

• If admitted for other than HIV-related illnessIf admitted for other than HIV-related illness

– Code first-listed diagnosis Code first-listed diagnosis

– Then 042 (HIV)Then 042 (HIV)

(Cont(Cont’’d…)d…)


Section I.C.1.a.2. Section I.C.1.a.2. Selection and sequencing Selection and sequencing of HIV codesof HIV codes(…Cont(…Cont’’d)d)

• SequenceSequence

• Reason most responsible for Reason most responsible for encounter, if HIV (042)encounter, if HIV (042)

– Any additional diagnosis that impacts Any additional diagnosis that impacts treatmenttreatment


Section I.C.1.a.2.g. HIV infection Section I.C.1.a.2.g. HIV infection in Pregnancy, Childbirth and the in Pregnancy, Childbirth and the PuerperiumPuerperium

• Exception to HIV sequencingException to HIV sequencing

• During pregnancy, childbirth, or During pregnancy, childbirth, or puerperium, code:puerperium, code:

– 647.6X (Other specified infections and 647.6X (Other specified infections and parasitic diseases) parasitic diseases)

– Followed by 042 (HIV) (stated diagnosis)Followed by 042 (HIV) (stated diagnosis)

– Then any HIV-related illnessThen any HIV-related illness



Section I.C.1.a.2.g. Section I.C.1.a.2.g. HIV and PregnancyHIV and Pregnancy(…Cont(…Cont’’d)d)

• Asymptomatic HIV during pregnancy, Asymptomatic HIV during pregnancy, childbirth, or puerperiumchildbirth, or puerperium

– 647.6X (Other specified infections and 647.6X (Other specified infections and parasitic diseases) and parasitic diseases) and

– V08 (Asymptomatic HIV infection status)V08 (Asymptomatic HIV infection status)


Section I.C.1.a.2.e. Section I.C.1.a.2.e. Patients with inconclusive Patients with inconclusive HIV serologyHIV serology

• 795.71 (Inconclusive serologic test 795.71 (Inconclusive serologic test for HIV)for HIV)


Section I.C.1.a.2.h. Section I.C.1.a.2.h. Encounters for testing for HIVEncounters for testing for HIV

• Code V73.89 (Screening for other Code V73.89 (Screening for other specified viral disease)specified viral disease)

– Patient in high-risk group for HIVPatient in high-risk group for HIV

– V69.5 (Other problems related to lifestyle)V69.5 (Other problems related to lifestyle)

• Patients returning for HIV screening Patients returning for HIV screening results = V65.44 (HIV counseling)results = V65.44 (HIV counseling)


CautionCaution

• Incorrectly applying these HIV coding Incorrectly applying these HIV coding rules can cause patient hardshiprules can cause patient hardship

– Insurance claims for patients with HIV Insurance claims for patients with HIV usually need patientusually need patient’’s written agreement s written agreement to discloseto disclose


Section I.C.1.b. Septicemia, Section I.C.1.b. Septicemia, Septic Shock and SIRSSeptic Shock and SIRS• Septicemia: systemic disease of Septicemia: systemic disease of

microorganisms or their toxins in the blood microorganisms or their toxins in the blood (blood poisoning) (blood poisoning)

• Septic shock: overwhelming infection due to Septic shock: overwhelming infection due to severe sepsissevere sepsis

• SIRS: SIRS: SSystemic ystemic IInflammatory nflammatory RResponse esponse SSyndrome is a systemic response to yndrome is a systemic response to infection/traumainfection/trauma

• Sepsis refers to SIRS due to infectionSepsis refers to SIRS due to infection• Severe sepsis is sepsis with acute organ Severe sepsis is sepsis with acute organ

dysfunctiondysfunction



Section I.C.1.b. Septicemia, Section I.C.1.b. Septicemia, Septic Shock and SIRSSeptic Shock and SIRS(…Cont(…Cont’’d)d)

• Code septicemia (038.XX)Code septicemia (038.XX)

• SIRS second (995.9X)SIRS second (995.9X)

• If documented, septic shock (785.52) should If documented, septic shock (785.52) should be reported be reported

• Sepsis and septic shock associated with OB Sepsis and septic shock associated with OB codes, also use code 630-633, Ectopic and codes, also use code 630-633, Ectopic and Molar Pregnancy Molar Pregnancy

• Septic shock is never primary or first-listed Septic shock is never primary or first-listed diagnosisdiagnosis


Sepsis and Severe Sepsis not Sepsis and Severe Sepsis not associated with noninfectious associated with noninfectious processprocess• Infection resulting from Trauma, Other Infection resulting from Trauma, Other

Serious Injury, PancreatitisSerious Injury, Pancreatitis

– Code Trauma/InjuryCode Trauma/Injury

– SIRS second (995.9X)SIRS second (995.9X)

– Any acute organ dysfunctionsAny acute organ dysfunctions

• When sepsis or severe sepsis is PDx, When sepsis or severe sepsis is PDx, sequence systemic infection & sepsis sequence systemic infection & sepsis codes before non-infectious conditioncodes before non-infectious condition


ICD-9-CM, Chapter 2 ICD-9-CM, Chapter 2 NeoplasmNeoplasm• • Two steps for coding neoplasms:Two steps for coding neoplasms:

1.1. Index: Locate histologic type of neoplasm (e.g., sarcoma, Index: Locate histologic type of neoplasm (e.g., sarcoma, melanoma)melanoma)

• Review all instructions Review all instructions

2.2. Locate code identified (usually in Neoplasm Table in Locate code identified (usually in Neoplasm Table in Index) by body siteIndex) by body site

• • Neoplasms Table divided into columns: Neoplasms Table divided into columns: 1.1. Malignant (primary,Malignant (primary, secondary, Ca in situ)secondary, Ca in situ)

2.2. BenignBenign

3.3. Uncertain behaviorUncertain behavior

4.4. UnspecifiedUnspecified


ICD-9-CM, Chapter 2 ICD-9-CM, Chapter 2 NeoplasmNeoplasmMorphology Codes-Appendix A ICD-9-CMMorphology Codes-Appendix A ICD-9-CM

• Codes are alpha numeric: M + 4 numeric characters, a Codes are alpha numeric: M + 4 numeric characters, a slash, followed by 5slash, followed by 5thth digit (indicates behavior) digit (indicates behavior)

• Assigned by tumor registry coderAssigned by tumor registry coder

/0= Benign/0= Benign

/1= Uncertain benign/malignant/borderline/1= Uncertain benign/malignant/borderline

/2=Carcinoma in situ/2=Carcinoma in situ

/3= Malignant, primary site/3= Malignant, primary site

/6= Malignant, secondary/metastatic site/6= Malignant, secondary/metastatic site

/9= Malignant, uncertain if primary/secondary site/9= Malignant, uncertain if primary/secondary site

• Not assigned in outpatient settingNot assigned in outpatient setting


Section I.C.2. NeoplasmsSection I.C.2. Neoplasms• Treatment directed at malignancy: Neoplasm Treatment directed at malignancy: Neoplasm

is first-listed diagnosisis first-listed diagnosis– Except for chemotherapy or radiotherapy:Except for chemotherapy or radiotherapy:

1.1. Therapy (treatment)Therapy (treatment)

2.2. NeoplasmNeoplasm

• Chemotherapy: V58.11—encounter for reason Chemotherapy: V58.11—encounter for reason the patient presents for treatment, #1 the patient presents for treatment, #1 diagnosisdiagnosis

• Radiotherapy: V58.0—encounter for reason Radiotherapy: V58.0—encounter for reason the patient presents for treatment, #1 the patient presents for treatment, #1 diagnosisdiagnosis



Section I.C.2. NeoplasmsSection I.C.2. Neoplasms(…Cont(…Cont’’d)d)

• Surgical removal of neoplasm and Surgical removal of neoplasm and subsequent chemotherapy or radiotherapysubsequent chemotherapy or radiotherapy

– Code malignancy as first-listed diagnosisCode malignancy as first-listed diagnosis

• Surgery to determine extent of malignancySurgery to determine extent of malignancy

– Code malignancy as first-listed diagnosisCode malignancy as first-listed diagnosis

– Code neoplasm as long as patient is receiving Code neoplasm as long as patient is receiving treatment or medication following excisiontreatment or medication following excision



Section I.C.2. NeoplasmsSection I.C.2. Neoplasms

• V10, V10, ““Personal history of malignant Personal history of malignant neoplasmneoplasm”” if if

– Neoplasm was previously Neoplasm was previously destroyed/removeddestroyed/removed

– No longer being treatedNo longer being treated




(…Cont(…Cont’’d)d)

• If patient receives treatment for If patient receives treatment for secondary neoplasm (metastasis):secondary neoplasm (metastasis):

– Secondary neoplasm is first-listed Secondary neoplasm is first-listed diagnosisdiagnosis

– Even though primary is known Even though primary is known

– Code primary neoplasm as secondary Code primary neoplasm as secondary diagnosis or if no longer treated code diagnosis or if no longer treated code personal history of...personal history of...





• Admission for symptoms of primary Admission for symptoms of primary or secondary neoplasm or secondary neoplasm

– Malignancy first-listed diagnosisMalignancy first-listed diagnosis

– Do NOT codeDo NOT code symptoms or signssymptoms or signs

• First-listed is site receiving treatmentFirst-listed is site receiving treatment

• If both primary and mets are treated, code If both primary and mets are treated, code primary as first-listedprimary as first-listed



Section I.C.2. NeoplasmSection I.C.2. Neoplasm


• Patient treated for anemia or dehydration Patient treated for anemia or dehydration due to neoplasm or therapydue to neoplasm or therapy

• CodeCode– Anemia or dehydration Anemia or dehydration

– NeoplasmNeoplasm

• Patient admitted for pain control due to Patient admitted for pain control due to neoplasm, 338.3neoplasm, 338.3



Section I.C.2. NeoplasmSection I.C.2. Neoplasm


• Patient admitted to repair complication Patient admitted to repair complication of surgery for an intestinal malignancyof surgery for an intestinal malignancy

– Complication first-listed diagnosisComplication first-listed diagnosis

• Complication is reason for encounterComplication is reason for encounter

– Malignancy secondary diagnosisMalignancy secondary diagnosis



V Codes and NeoplasmsV Codes and Neoplasms

• Patient receiving chemotherapy or Patient receiving chemotherapy or radiotherapy post-op removal of radiotherapy post-op removal of neoplasm neoplasm

• Code:Code:

1.1. TherapyTherapy

2.2. Active neoplasm still being treatedActive neoplasm still being treated

• Do NOT report H/O (history of) neoplasmDo NOT report H/O (history of) neoplasm



• Endocrine, Nutritional, and Metabolic Endocrine, Nutritional, and Metabolic Diseases and Immunity DisordersDiseases and Immunity Disorders


Disorders of Other Disorders of Other Endocrine GlandsEndocrine Glands• Diabetes Mellitus 250 coded frequentlyDiabetes Mellitus 250 coded frequently

– Subterms often have two codesSubterms often have two codes

– Example: Example:

1.1. Diabetic iritis 250.5X for diabetes (etiology) Diabetic iritis 250.5X for diabetes (etiology)

2.2. [364.42][364.42] for iritis (manifestation) for iritis (manifestation)

• Metabolic manifestation only one code Metabolic manifestation only one code assignment, e.g., diabetic ketoacidosis assignment, e.g., diabetic ketoacidosis (250.1X)(250.1X)



Disorders of Other Disorders of Other Endocrine GlandsEndocrine Glands(…Cont(…Cont’’d)d)

• Fifth digit indicates type of diabetesFifth digit indicates type of diabetes– Adult or juvenileAdult or juvenile

0, 2: Type0, 2: Type IIII• 0 Type II or unspecified type, not stated as 0 Type II or unspecified type, not stated as

uncontrolleduncontrolled• 2 Type II or unspecified type uncontrolled2 Type II or unspecified type uncontrolled

1, 3: Type I1, 3: Type I• 1 Juvenile type, not stated as uncontrolled1 Juvenile type, not stated as uncontrolled• 3 Juvenile type, uncontrolled3 Juvenile type, uncontrolled



Disorders of Other Disorders of Other Endocrine GlandsEndocrine Glands• Type I—Insulin dependent—pancreas does Type I—Insulin dependent—pancreas does

not produce insulinnot produce insulin

• Type II—non-insulin dependent—(can be on Type II—non-insulin dependent—(can be on insulin)insulin)

• ““UncontrolledUncontrolled””—must be documented by —must be documented by physicianphysician– Can use Can use ““out of controlout of control””

– Cannot assign Cannot assign ““uncontrolleduncontrolled”” status when status when documentation states documentation states ““poorly controlledpoorly controlled””



Disorders of Other Disorders of Other Endocrine GlandsEndocrine Glands(…Cont(…Cont’’d)d)

• V58.67 in addition to diabetes code to V58.67 in addition to diabetes code to indicate long-term use of insulinindicate long-term use of insulin

• If type is not indicated, code Type II If type is not indicated, code Type II diabetesdiabetes

• Patient with Type II diabetes can Patient with Type II diabetes can receive insulinreceive insulin

• Type I diabetic is insulin dependentType I diabetic is insulin dependent


Other Metabolic and Immunity Other Metabolic and Immunity Disorders SectionDisorders Section• Disorders such as gout and Disorders such as gout and

dehydrationdehydration

• Disorders often have many namesDisorders often have many names

– 242.0X Toxic diffuse goiter also known as:242.0X Toxic diffuse goiter also known as:

• BasedowBasedow’’s diseases disease

• GravesGraves’’ disease disease

• Primary thyroid hyperplasiaPrimary thyroid hyperplasia



• Diseases of Blood and Blood-Forming Diseases of Blood and Blood-Forming OrgansOrgans

• Short chapter with 10 sectionsShort chapter with 10 sections

• Includes anemia, blood disorders, Includes anemia, blood disorders, coagulation defects coagulation defects



Chapter 4Chapter 4(…Cont(…Cont’’d)d)

• Often used code, anemiaOften used code, anemia

• Many different types of anemia: Many different types of anemia: – Hereditary hemolytic (282)Hereditary hemolytic (282)

– Iron deficiency (280)Iron deficiency (280)

– Acquired hemolytic (283)Acquired hemolytic (283)

• Multiple coding often necessary Multiple coding often necessary

• Identify underlying disease conditionIdentify underlying disease condition



Chapter 4Chapter 4(…Cont(…Cont’’d)d)

Two confusing anemias:Two confusing anemias:

• anemia of chronic diseaseanemia of chronic disease

– disease causing anemia is chronicdisease causing anemia is chronic

– Code 285.2x and then the appropriate code Code 285.2x and then the appropriate code for the chronic diseasefor the chronic disease

• chronic simple anemiachronic simple anemia

– Anemia (285.9), chronic simple (281.9)Anemia (285.9), chronic simple (281.9)


ICD-9-CM, Chapter 5, Mental ICD-9-CM, Chapter 5, Mental DisordersDisorders• Includes codes forIncludes codes for

– Personality disorders Personality disorders

– Stress disordersStress disorders

– NeurosesNeuroses

– Psychoses Psychoses

– Sexual deviation/dysfunction, etc.Sexual deviation/dysfunction, etc.

– Mental retardationMental retardation



Chapter 5Chapter 5


• Fifth digit = status of episodeFifth digit = status of episode

• Example: 304, Drug dependence has Example: 304, Drug dependence has following fifth digits:following fifth digits:

0: unspecified (episode)0: unspecified (episode)

1: continuous1: continuous

2: episodic2: episodic

3: in remission3: in remission



• Diseases of Nervous System and Diseases of Nervous System and Sense OrgansSense Organs

– Central Nervous SystemCentral Nervous System

– Peripheral Nervous SystemPeripheral Nervous System

– Disorders of Eye and AdenexaDisorders of Eye and Adenexa

– Diseases of Ear and Mastoid ProcessDiseases of Ear and Mastoid Process


Pain not elsewhere classified (338)Pain not elsewhere classified (338)• Acute or chronic pain due to:Acute or chronic pain due to:

– TraumaTrauma

– PostoperativePostoperative

– NeoplasmNeoplasm

– Psychosocial dysfunctionPsychosocial dysfunction

• NOT for generalized or localized painNOT for generalized or localized pain

• First-listed/primary diagnosisFirst-listed/primary diagnosis

– When definitive diagnosis not establishedWhen definitive diagnosis not established

– Pain management is reason for encounter/admissionPain management is reason for encounter/admission


ICD-9-CM, Chapter 7—Diseases of ICD-9-CM, Chapter 7—Diseases of Circulatory SystemCirculatory System

• Three types of hypertension: Three types of hypertension:

– MalignantMalignant——acceleratedaccelerated

– BenignBenign——continuous, mild (BPcontinuous, mild (BP) controllable, no ) controllable, no irreversible vascular changesirreversible vascular changes

– UnspecifiedUnspecified——NOT indicated as either malignant or NOT indicated as either malignant or benign (.9)benign (.9)

• Hypertension table located in IndexHypertension table located in Indexof ICD-9-CMof ICD-9-CM

– Under Under ““HH””, Hypertension, Hypertension

– Locate nowLocate now


Section I.C.7.a.1. Section I.C.7.a.1. Hypertension, Essential, or NOSHypertension, Essential, or NOS

• Assign hypertensionAssign hypertension

– arterialarterial

– essentialessential

– primaryprimary

– systemicsystemic

– NOS to 401 NOS to 401

• Fourth digit to indicate type, 401.XFourth digit to indicate type, 401.X


Section I.C.7.a.2. Hypertension Section I.C.7.a.2. Hypertension with Heart Diseasewith Heart Disease

• 402 Category402 Category

• Certain heart conditions when stated Certain heart conditions when stated ““due to hypertensiondue to hypertension”” or implied or implied ((““hypertensivehypertensive””))

• AddAdd fourthfourth digit for typedigit for type

• Use additional code to specify type of Use additional code to specify type of heart failure (428)heart failure (428)


Section I.C.7.a.3. Hypertensive Section I.C.7.a.3. Hypertensive Chronic Kidney DiseaseChronic Kidney Disease• Cause-and-effect relationship assumed in Cause-and-effect relationship assumed in

chronic kidney disease with hypertensionchronic kidney disease with hypertension

• Category 403, Hypertensive chronic kidney Category 403, Hypertensive chronic kidney disease, used when:disease, used when:

– Category 585 or code 587 are present with Category 585 or code 587 are present with hypertension hypertension

• With 403 assign fifth digit 0 stage I-IV or With 403 assign fifth digit 0 stage I-IV or unspecified and 1 for stage V or end stage unspecified and 1 for stage V or end stage renal diseaserenal disease


Section I.C.7.a.4. Hypertensive Section I.C.7.a.4. Hypertensive Heart and Chronic Kidney Heart and Chronic Kidney DiseaseDisease• AssignAssign 404 when 404 when bothboth hypertensive hypertensive

chronic kidney disease and chronic kidney disease and hypertensive heart disease statedhypertensive heart disease stated

• Assume cause-and-effect relationship Assume cause-and-effect relationship

• Assign fifth digit for mention of heart Assign fifth digit for mention of heart failure, and/or kidney failure stages I-IV failure, and/or kidney failure stages I-IV or end stage renal diseaseor end stage renal disease– Use additional code from category 428, Use additional code from category 428,

identifying type of heart diseaseidentifying type of heart disease


Stages of Chronic Kidney DiseaseStages of Chronic Kidney Disease

• Stage I: Stage I: Blood flow through kidney increases, kidney Blood flow through kidney increases, kidney enlarges enlarges (585.1)(585.1)

• Stage II: Stage II: (mild) Small amounts of blood protein (albumin) (mild) Small amounts of blood protein (albumin) leaks into urine (microalbuminuria) (585.2)leaks into urine (microalbuminuria) (585.2)

• Stage III: Stage III: (moderate) Albumin and other protein losses (moderate) Albumin and other protein losses increase. Patient may develop high BP and kidneyincrease. Patient may develop high BP and kidney’’s s filter ability filter ability (585.3)(585.3)

• Stage IV: Stage IV: (severe) Large amounts of urine pass through (severe) Large amounts of urine pass through kidney, blood pressure increases (585.4)kidney, blood pressure increases (585.4)

• Stage V: Stage V: Ability to filter waste nearly stops (585.5)Ability to filter waste nearly stops (585.5)

• End stage renal failure (585.6)End stage renal failure (585.6)

– When documentation indicates chronic renal disease When documentation indicates chronic renal disease (CKD) and ESRD, report ESRD(CKD) and ESRD, report ESRD

• Unspecified 585.9Unspecified 585.9


Section I.C.7.a.5. Hypertensive Section I.C.7.a.5. Hypertensive Cerebrovascular DiseaseCerebrovascular DiseaseCode:Code:

• Cerebrovascular disease (430-438) firstCerebrovascular disease (430-438) first

• Type of hypertension (401-405) secondType of hypertension (401-405) second


Section I.C.7.a.6. Section I.C.7.a.6. Hypertensive RetinopathyHypertensive Retinopathy

Code:Code:

• Hypertensive retinopathy first (362.11)Hypertensive retinopathy first (362.11)

• Type of hypertension (401-405) secondType of hypertension (401-405) second


Section I.C.7.a.7. Section I.C.7.a.7. Hypertension, SecondaryHypertension, Secondary• Hypertension caused by an underlying Hypertension caused by an underlying

conditioncondition

– Code:Code:

1.1. Underlying condition firstUnderlying condition first

2.2. Type of hypertension (405) secondType of hypertension (405) second


Section I.C.7.a.8. Section I.C.7.a.8. Hypertension, TransientHypertension, Transient• Transient hypertension: Temporary Transient hypertension: Temporary

elevation of BP elevation of BP

• DO NOT assign 401-405 Hypertensive DO NOT assign 401-405 Hypertensive Disease Disease

– Hypertension diagnosis NOT establishedHypertension diagnosis NOT established

– Instead use:Instead use:

• 796.2, Elevated blood pressure796.2, Elevated blood pressure

• 642.3X, Transient hypertension of pregnancy642.3X, Transient hypertension of pregnancy


Section I.C.7.a.9. Section I.C.7.a.9. Hypertension, ControlledHypertension, Controlled• Hypertension controlled by therapyHypertension controlled by therapy

– Assign code from 401-405Assign code from 401-405


Section I.C.7.a.10. Section I.C.7.a.10. Hypertension, UncontrolledHypertension, Uncontrolled• Untreated hypertensionUntreated hypertension

• Uncontrolled hypertensionUncontrolled hypertension

• Assign code from 401-405Assign code from 401-405


Section I.C.7.a.11. Elevated Section I.C.7.a.11. Elevated Blood PressureBlood Pressure• Elevated blood pressure coded 796.2Elevated blood pressure coded 796.2

– Elevated BP reading without hypertension Elevated BP reading without hypertension diagnoseddiagnosed

– Hypertension NOT stated, NOT coded to Hypertension NOT stated, NOT coded to 401 (essential hypertension)401 (essential hypertension)


ICD-9-CM, Chapter 7—Diseases ICD-9-CM, Chapter 7—Diseases of Circulatory Systemof Circulatory System

• Code 410 Acute Myocardial Infarction (MI) Code 410 Acute Myocardial Infarction (MI) requires a fifth digit:requires a fifth digit:

““11”” Initial episode of care for MI Initial episode of care for MI

• May be reported by more than one facility, if May be reported by more than one facility, if patient transferredpatient transferred

““22”” Subsequent care Subsequent care

• Patient re-admitted for testing/treatment within the Patient re-admitted for testing/treatment within the first eight (8) weeks of initial episodefirst eight (8) weeks of initial episode

• Code 412 reported for old/healed MICode 412 reported for old/healed MI

– No symptomsNo symptoms


Chapter 8, Diseases of Chapter 8, Diseases of Respiratory SystemRespiratory System• Watch for: Watch for: ““Use additional code to Use additional code to

identify infectious organismidentify infectious organism””

– Some codes indicate specific organism Some codes indicate specific organism and do not need an additional codeand do not need an additional code


Respiratory Failure (RF) Respiratory Failure (RF) SequencingSequencing• If RF due to an acute condition (e.g., MI) If RF due to an acute condition (e.g., MI)

or acute exacerbation of chronic or acute exacerbation of chronic condition (e.g., COPD)condition (e.g., COPD)

• Per new guidelines, if there are no Per new guidelines, if there are no chapter-specific guidelines (OB, chapter-specific guidelines (OB, poisoning) regarding sequencing, poisoning) regarding sequencing, either RF or acute condition may be either RF or acute condition may be first-listed diagnosisfirst-listed diagnosis


Acute Respiratory Infection Acute Respiratory Infection SectionSection

• Frequently used codes, such as:Frequently used codes, such as:– Common cold (Common cold (460460, acute nasopharyngitis), acute nasopharyngitis)– Sore throat (Sore throat (462462, acute pharyngitis), acute pharyngitis)– Acute tonsillitis (Acute tonsillitis (463463))– Bronchitis (490-491)Bronchitis (490-491)– Acute upper respiratory infection (Acute upper respiratory infection (465.9465.9, URI), URI)– Influenza (Influenza (487487, flu), flu)

Read Guidelines for Chapter 8 for specifics Read Guidelines for Chapter 8 for specifics on coding COPD and asthmaon coding COPD and asthma


ConclusionConclusionCHAPTER 5CHAPTER 5

CHAPTER-SPECIFIC GUIDELINES CHAPTER-SPECIFIC GUIDELINES (ICD-9-CM CHAPTERS 1-8) (ICD-9-CM CHAPTERS 1-8)

CHAPTER 5

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